Provider Demographics
NPI:1295853158
Name:PRINCE, JACQUELYNNE B (APRN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYNNE
Middle Name:B
Last Name:PRINCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1928 ALCOA HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1502
Mailing Address - Country:US
Mailing Address - Phone:865-305-6570
Mailing Address - Fax:865-305-6576
Practice Address - Street 1:1928 ALCOA HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1502
Practice Address - Country:US
Practice Address - Phone:865-305-6570
Practice Address - Fax:865-305-6576
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN92590363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS77855Medicare UPIN